Spasmodic Dysphonia vs. Muscle Tension Dysphonia Flashcards
Dystonia
neurological disorder that is characterized by involuntary muscle contractions which force certain parts of the body into abnormal, sometimes painful, movements or positions
Focal Dystonia
Affects only one part of the body: Blephrospasm Cervical Dystonia-torticollis Oromandibular Dystonia Writer's cramp Hemifacial spasm Laryngeal Dystonia--Spasmodic Dysphonia
Laryngeal Dystonia
Adductor
Abductor
Mixed
Tremor
Cause of Laryngeal Dystonia
unknown
originates in basal ganglia
onset in some cases may be triggered by trauma
Genetic factor is suspected in 10-20% chromosome 9
Incidence of Laryngeal Dystonia
30,000-50,000
generally between 40-50 years of age
more women than men
Components of a differential diagnosis of Spasmodic Dystonia
Team: SLP, Oto, Neuro History Perceptual Stroboscopy EMG
History Component
Failure of multiple treatments
better when singing, laughing, yawning, yelling, whispering and with alcohol
worse with stress, on phone, with continuous talking
Videostroboscopy
Normal (periodic, symmetrical mucosal wave, full length of VC without hyperadduction)
Aductor Laryngeal Dystonia Perceptual Eval
voice is strained, strangled and choked in quality
Often abrupt initiations and terminations of voicing resulting in voice breaks
effortful speech, fatigue
voice breaks on vowels and voiced consonants
continuum of severity
compensatory strategies
Aductor Laryngeal Dystonia Videostroboscopy
aperiodic mucosal wave
decreased amplitude
intermittent FVC approximation
intermittent anterior/posterior compression
Abductor Laryngeal Dystonia Perceptual Eval
whispered, breathy quality of voice breathy voice breaks effortful speech, fatigue voice breaks typically on unvoiced consonants Continuum of severity Compensatory strategies
Abductor Laryngeal Dystonia Videostroboscopy
effort to maintain closure in sustained phonation
Increased amplitude
Abduction of vocal cords during voice breaks
Mixed Laryngeal Dystonia Perceptual Eval
symptoms of both adductor and abductor laryngeal dystonia
Often but not always a predominance of adductor symptoms
Mixed Laryngeal Dystonia Videostroboscopy
intermittent FVC approximation and anterior posterior compression during voice breaks
intermittent abduction of TVCs during voice breaks
Tremor Laryngeal Dystonia Perceptual Evaluation
shaky voice, often unable to sustian steady sound
Tremor may be consistent or intermittent
Often accompanied by symptoms of adductor laryngeal dystonia
Tremor Laryngeal Dystonia Videostroboscopy
Presence of intermittent or consistent tremor
Tremor between 3-6 Hz
May occur alone, with hyperadduction during breaks or with abduction of VCs during breaks
Muscle Tension Dysphonia
implies any increase in laryngeal muscle tension resulting in a voice disorder
Muscle Misuse Voice Disorders
Laryngeal isometric
Lateral contraction
Anteroposterior supraglottic contraction
Vocal cord splinting
Vocal Cord Splintin
conversion aphonia/dysphonia
psychogenic dysphonia with bowed vocal folds
habituated hoarseness
Potential Misdiagnoses of Muscle Tension Dysphonia
Adductor laryngeal dystonia
Abductor larygeal dystonia
Spasmodic Dystonia
failure of multiple treatments
better with winging laughing, yawning yelling whispering and with alcohol
worse with stress on the phone and with continuous talking
worse voice with loud and low pitched voice
better voice with soft and high pitched voice
Muscle Tension Dysphonia
+/- response to treatment
rarely better with singing or yelling or with alcohol
notice no difference on the phone–worse with overuse
no effect with loud and low pitched voice
No effect with soft and high pitched voice
Speech Therapy
MTD likely responds to therapy
SD reveals itself (breaks) during therapy
IF no change from therapy consider Botox
Botox treatment
Successful response=SD
Extreme side effects=MTD
